Provider Demographics
NPI:1538305008
Name:DASHTY, KOUROSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KOUROSH
Middle Name:
Last Name:DASHTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 N MACARTHUR BLVD
Mailing Address - Street 2:STE. 124-519
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9400 N MACARTHUR BLVD
Practice Address - Street 2:STE. 124-519
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-4705
Practice Address - Country:US
Practice Address - Phone:909-528-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist